Sidney Wallace

Arterial occlusion of pelvic bone tumors

Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, I aneurysmal bone cyst, I recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and I metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.

Computed tomography in liposarcoma.

Seventeen cases with proven liposarcoma were evaluated by computed tomography (CT) to assess the specificity and value of this radiographic modality. A specific diagnosis of liposarcoma could be made in only four cases (22%). Despite its relative nonspecificity, CT proved extremely useful in the clinical evaluation of this tumor and evidenced considerable superiority to other radiographic methods. In several cases, CT was the only radiographic modality to demonstrate the presence of the lesion. The use of CT gained additional important information in approximately 50% of the cases studied.

Radiologic features of adrenal metastases

The incidence of adrenal metastasis is surprisingly high with certain types of malignant neoplasms such as carcinoma of the breast and lung, and melanoma. Since adrenal metastases are usually clinically silent, radiologic findings assume greater importance. The radiologic features found in 21 patients with proved adrenal metastases are presented.

Percutaneous transfemoral renal artery occlusion in patients with renal carcinoma preliminary report

Twenty-four patients have undergone percutaneous transfemoral selective renal artery occlusion as part of their management for renal carcinoma. Preoperative infarction was performed in 7 cases. This facilitated surgery by eliminating the major blood supply to the tumor and resulted in collapse of the large collateral veins and created edema within the perirenal tissue. In 17 patients with visceral metastases, tumor infarction was performed in lieu of nephrectomy for control of the primary lesion and in hopes of stimulating an autoimmune response. The current status of this procedure s discussed in light of its indications, complications, and preliminary results.

Transcatheter intraarterial infusion of chemotherapy in advanced bladder cancer

Bilateral internal iliac artery infusion of chemotherapeutic agents in patients with advanced bladder carcinoma, Stage D, resulted in a 50% response or greater in nine of 15 patients with a median survival, thus far, of 52 weeks. Hematuria was controlled in eight of ten patients, and pain was relieved in 12 of 15 patients. Three additional patients were treated as adjuvants after their residual tumor was removed surgically or irradiated before chemotherapy. Cis‐diamminedichloroplatinum (CDDP) was infused at a dose of 80–120 mg/m2 over a 24‐hour period. When CDDP failed or in the presence of impaired renal function, a combination of 5‐fluorouracil (5‐FU) infused intraarterially while Adriamycin and mitomycin C were delivered intravenously, salvaged two patients. Complications were tolerable, consisting of transient acute tubular necrosis in two patients, a lower extremity embolus in one, and skin reactions due to 5‐FU in two patients.

Current status of transcatheter management of neoplasms

Transcatheter arterial infusion and arterial embolization are employed in the treatment of various neoplasms. In patients with carcinoma of the colon metastatic to the liver, the hepatic arterial infusion (HAI) of floxuridine and Mitomycin© produced a 55% partial response and a 12% complete response, as well as an improved median survival of 18 months. In metastatic breast carcinoma, a 30% response was achieved. In some cases, proximal embolization of aberrant hepatic arteries was performed to redistribute the hepatic flow to a single vessel to assist infusion of the entire liver using a single catheter. Devascularization by hepatic artery embolization has also been used to treat hepatic neoplasms. Arterial occlusion of renal carcinoma, followed after four to seven days by nephrectomy and hormonal therapy, produced a 36% response rate in 49 patients with distant metastases. In 14 patients with osteosarcoma treated with cis-diaminedichloroplatinum (CDDP) arterial infusion, a 57% response rate was achieved. Benign bone tumors were treated with arterial occlusion with a 60% response rate. Tumors of the pelvis were managed by bilateral internal iliac artery infusion using CDDP. In 21 patients with recurrent bladder carcinoma, control of pain and hematuria and prolonged survival were achieved.

Metastatic osteogenic sarcoma to the brain

The radiographic appearances of intracranial metastases from primary osteogenic sarcomas in three patients are presented. In two patients, the diagnosis of metastatic disease could be made on conventional roentgenograms of the skull since mineralization of tumor osteoid could be seen within the brain parenchyma. This had a similar appearance to the primary bone tumor. Angiography in two of the three patients revealed the cerebral metastases to be hypervascular with tumor vessels, tumor stain and early draining veins. Cancer 43:707–710, 1979.

Intrarenal arteriovenous fistulas: transcatheter steel coil occlusion.

Intrarenal arteriovenous fistulas are either congenital (cirsoid), acquired or idiopathic. Transcatheter occlusion of these fistulas was accomplished using the Gianturco stainless steel coil. The anatomical configuration of the feeding and draining vessels dictated the technical approach. There was considerable conservation of renal tissue as the result of this non-surgical therapeutic alternative.

Arterial infusion and occlusion in cancer patients.

RANSCATHETER intraarterial infusion and occlusion techniques are being adapted to the percutaneous management of selected cancer patients. Because of ready access to the vascular supply of the tumor and the resulting reduced morbidity and mortality, the interventional radiologist has applied the percutaneous approach to a wide variety of neoplastic diseases. The rationale of intraarterial infusion is to expose the neoplasm to a higher local concentration of chemotherapeutic agent than with intravenous administration without increasing toxicity. Most cytotoxic agents have a steep dose response curve; ie, the higher the concentration of the drug, the higher the antitumor effect.’ The systemic concentration and therefore systemic toxicity will usually be the same whether the agent is delivered intravenously or intraarterially. However, a neoplasm that is refractory to systemic chemotherapy may respond to arterial infusion of the same agent at the same dose rate.’ Infusion should be differentiated from per+ don; the latter is an attempt to isolate the tumor circulation by introducing the agent selectively into the nutritive artery and withdrawing it from the venous drainage of the neoplasm in order to recirculate the drug and minimize its systemic toxic effect. The terms embofization, occlusion,

Comparison of ultrasound and computed tomography in the detection of pancreatic malignancy

A retrospective analysis was performed on 102 patients who were examined by both ultrasound (US) and computed tomography (CT) for known or possible carcinoma of the pancreas. In 38% of the patients, ultrasonography was unsatisfactory due to overlying interfering intestinal gas or ascites, whereas only 2% of CT studies were unsatisfactory due to technical considerations. In comparing the two modalities, CT was found to be more accurate (96% CT vs. 84% US), and this became more significant when nondiagnostic studies were considered in evaluating accuracy (95% CT vs. 54% US). Because of the findings in this analysis, CT is recommened as the initial diagnostic imaging modality for the evaluation of possible pancreatic neoplasm.